Managing Lower Back Pain: Symptoms, Causes, Treatment & Prevention

What is Lower Back Pain?

Lower back pain is discomfort occurring in the lumbar region, the area between your ribs and pelvis. It's very common and often caused by muscle strain, disc injuries, or underlying health issues. The pain usually improves within a few weeks but can sometimes persist or recur. Treatment typically includes rest, gentle exercises, and pain relief strategies to ease discomfort and support recovery.

Causes of Lower Back Pain

Lower back pain is a common occurrence these days, and over 80% of people experience at least one episode of lower back pain in their lifetime.

In most cases, there is no apparent underlying cause. However, in some cases, the pain can be attributed to a medical condition or disease. Common causes include:

• Degenerative disc disease: Normal wear and tear can lead to degenerative disc disease over time due to the formation of small cracks and tears and/or the loss of fluid in the spinal discs. This can result in changes to the adjacent spinal vertebrae, including the development of bone spurs.
• Bulging and herniated disc: Excessive wear and tear on spinal discs can result in disc bulges, where the outer covering weakens, and the disc protrudes. Some people may experience pain that radiates down the back of the leg when the bulging disc compresses a nerve. This condition is known as sciatica.
• Lumbar spinal stenosis: This is a condition where the vertebral canal, the open space inside the vertebrae, becomes narrowed.
• Osteoarthritis: This condition can affect the facet joints (joints that connect the spinal vertebrae).
• Ankylosing spondylitis: This condition is a type of arthritis that causes inflammation in the spine and other parts of your body. Over time, it can cause stiffness due to inflammation in the joints and tissues of the spine. In severe cases, this may lead to vertebrae fusion that can result in a rigid and inflexible spine.
• Spondylolisthesis: This is a condition where one of the lower spine vertebrae "slips" forward relative to another.
• Occupational back pain: Poor posture while standing or sitting at work, driving long distances and improper lifting techniques can result in low back pain.

Types of Low Back Pain

Low back pain is generally classified into three main types based on its cause and severity:

1. Non-specific Lower Back Pain

This is the most common form of back pain. In most cases, the exact cause cannot be identified, which is why it's termed "non-specific." It is often associated with poor posture, muscle strain, or minor injuries, but typically resolves with rest, exercise, or physiotherapy.

2. Sciatica (nerve root pain)

Affecting a smaller group (about 1 in 20 people with low back pain), sciatica occurs when a nerve root in the lower spine is compressed or irritated. This can result in pain that radiates down the leg, accompanied by numbness or a tingling sensation (known as "pins and needles"). Sciatica often requires a more targeted treatment approach and should be assessed by a physiotherapist or medical professional.

3. Serious Spinal Pathology (red flags)

Rarely (less than 1 in 100 cases), low back pain is a symptom of a serious underlying condition. These are referred to as "red flag" symptoms and include signs such as loss of bladder or bowel control, numbness around the genitals or buttocks, loss of sensation or strength in both legs, unexplained weight loss, fever, or a history of cancer or recent trauma. These symptoms require immediate medical attention to rule out serious spinal or systemic conditions.

When to Visit a Doctor for Lower Back Pain

Although back pain does not typically indicate a serious medical condition and normally resolves on its own fairly quickly without treatment, it can be bothersome when it interferes with daily activities.

You should visit an orthopaedic specialist if you have any of the following lower back symptoms:

• Prolonged back pain for more than 4 weeks
• Severe pain that does not improve with rest
• If pain radiates down the back of your leg
• Weakness, numbness, or tingling in one or both legs
• Back pain with unexplained fever or weight loss
• Back pain due to falls, mainly if you are older than 50 years
• New back pain if you are 70 years or older

Diagnosis of Lower Back Pain

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Most individuals with low back pain recover within a few weeks without the need for imaging tests. Therefore, imaging tests are not routinely done for all patients with low back pain.

In certain circumstances, imaging tests such as X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be recommended if there are the following situations:

• The patient is experiencing low back pain that has persisted for more than four to six weeks, and the cause is unknown.
• There are risk factors or signs of infection or malignancy.
• Surgery is being considered.

Treatment Options for Lower Back Pain

The treatment option for lower back pain will depend on your symptoms and the severity of your condition. Treatment aims to relieve your symptoms, enable you to carry out your regular activities, and prevent further complications. Here are some recommended measures that may help reduce lower back pain.

1. Remain active

   Staying active as much as possible is good for your back because movement helps relieve pain while preventing loss of muscle strength. If your back pain is severe, you may need to rest for a day or two. However, prolonged bed rest is not recommended.

2. Heat and medication for pain relief

   A heated wrap or heating pad may help with back pain.

   Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are prescribed to reduce pain and swelling. Muscle relaxants such as cyclobenzaprine may help relieve back pain. As they can cause drowsiness, they are to be taken during bedtime.

3. Physiotherapy

   Physiotherapy with an individualised exercise program that includes stretching, flexion, extension, and strengthening may be beneficial.

4. Changes to work and lifestyle

   It may be necessary to take time off work to recover if you are unable to sit or stand comfortably at your job.

   Lifestyle changes such as weight loss, stress reduction, the use of back support devices, and increasing physical activities are a few ways that can improve your lower back pain issues.

5. Surgery

   Surgery is only recommended or considered in those with persistent radiculopathy due to spinal stenosis or herniated disc that have not responded to other therapies.

Lower Back Pain Prevention

Always use the right approach when performing certain activities such as the following:

• Use proper lifting techniques to avoid straining your back.
• Maintain good posture when sitting or standing for extended periods.
• Maintain a healthy weight to reduce pressure on your spine.
• Ensure proper sleeping positionsto support your back overnight.
• Stay active and try to continue with your daily activities, even if you experience mild discomfort.
• Take anti-inflammatory medication like ibuprofen if needed. Paracetamol alone is not recommended, but may be used with another painkiller.
• Apply an ice pack (or a bag of frozen peas wrapped in a towel) to reduce pain and swelling.
• Use a heat pack or hot water bottle (wrapped in a towel) to ease joint stiffness or muscle spasms.
• Practice regular back exercises and gentle stretches to strengthen muscles and improve flexibility.

Book an Appointment at Gleneagles Hospitals

The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care. Get in touch with us to book an appointment with an Orthopaedic specialist at Gleneagles Hospital today.

References

1. OrthoInfo: Low Back Pain. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/low-back-pain/ [Accessed 10 January 2023]
2. Chou R. Patient education: Low back pain in adults (Beyond the Basics). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Available at: https://www.uptodate.com/contents/low-back-pain-in-adults-beyond-the-basics#H16 [Accessed 22 April 2023]